Expanding Medicaid Adult Dental Coverage to Close the Gap

Despite the role oral health plays in a person’s overall health, some states are still placing dental care on the back burner when it comes to adult dental coverage under Medicaid. States have to make difficult decisions as they work to balance tough budgets. That said, states shouldn’t let the health of underserved residents become less of a priority by eliminating crucial oral health benefits. As dental professionals, we understand the associated pain and suffering untreated dental disease can cause, as well as the financial strain untreated dental disease can place on individuals and the healthcare system.

Fortunately, the Affordable Care Act has given states the opportunity to expand their Medicaid programs which has led many states to revisit the importance of adult dental benefits. In the past year, nine states have been actively reviewing Medicaid adult dental coverage, 12 states offer extensive benefits to their adult members, 20 offer limited benefits, 16 offer emergency benefits, and 3 offer no benefits. Below are a few examples:

As a result of legislative and community outreach efforts, Washington state now offers a comprehensive Medicaid dental benefit.

South Carolina continues to offer emergency dental benefits and is expanding the program to also cover preventive services -- cleanings, fillings, and extractions for adults over the age of 21 covered by Medicaid with a maximum benefit of $750 per member per year.

Many states have gone back and forth on the extent to which they cover dental benefits for adults. However, this back and forth can create inconsistent care as people without reliable dental coverage often do not participate in the routine dental visits that are necessary to prevent the costly chronic diseases that are associated with poor oral health. Also, many people without access to dental insurance who are confronted with dental problems visit the emergency rooms, even when they do not need emergency treatment, resulting in large medical bills for the hospital and the patient.

We believe strongly in our mission to improve the oral health of all so we are tackling the root cause of this issue from a number of angles. In addition to advocating for the inclusion of adult dental benefits in Medicaid programs across the country, DentaQuest is working to strengthen the safety net care delivery framework for the 85 million Americans that lack dental coverage. Through grants and technical assistance, both the DentaQuest Institute and DentaQuest Foundation are helping safety net dental programs across the United States meet their mission of providing high-quality dental care to underserved populations.

Across the country, we partner with local organizations to fund outreach events to improve access to oral health. For example, we recently worked with the South Carolina Dental Association to provide funding for Dental Access Days (DAD). DADs and Mission of Mercy (MOM) clinics send trusted volunteers into local communities to provide free dental care to adults in need. MOM and DAD events are extremely helpful to those in need, but they are a stop-gap, not a solution to this nationwide problem.

Additionally, the DentaQuest Foundation’s Oral Health 2020 goals target adult dental benefits in publicly-funded health insurance programs, like Medicare and Medicaid. This is a lofty goal and will require community involvement at all levels to achieve.

Our vision is that all people can receive appropriate dental care from childhood through adulthood, and as a result, avoid the pain and financial burden of untreated oral disease.